Modern medicine is so advanced that most congenital heart diseases can be detected by doctors through ultrasound scans of the mother’s body while still in the fetal stage. Most congenital heart diseases are not serious, and even in the more serious cases, doctors can give the best care and treatment after the baby is born, so the probability that the congenital heart disease they have will return to normal function is very high.
He said that parents should not be overly anxious when they are informed of problems such as holes in the fetus’ heart, nor should they consider aborting the pregnancy process, as was the case in the old days.
Most babies are not seriously ill, according to medical statistics, one in 120 babies has congenital heart disease, only most of them are not seriously ill. Congenital heart disease includes structural abnormalities in the walls and valves of the heart, the blood vessels that connect it. These defects often cause changes in blood flow pathways that can affect the health of the heart and lungs, into which can affect the normal development of the infant, and sometimes can be life-threatening.
When congenital heart disease causes serious problems, it requires emergency treatment including surgery or interventional therapy, or in some cases, just medication, said Dr. Guo Ruicai, a senior consultant in pediatric cardiology who is also the chief of pediatric cardiology. Even if a small number of congenital heart defects go undetected during scans and examinations of pregnant women, they can show signs at different stages of growth.
A heart with a murmur is not necessarily abnormal
In the developmental records that the Ministry of Health promotes for every child, health care providers and even parents can see some abnormalities. Some are found to have heart problems during exams done at different times in school, while others don’t show up until they join the military.
”When doctors examine a child’s heart, they often hear additional or unusual sounds that occur during the heartbeat, called heart murmurs. However, many times these murmurs are benign and their hearts are normal and able to operate healthily, so they need not be ignored.” Of course, doctors can often detect from these murmurs that a child is actually suffering from some kind of congenital heart disease.
Some symptoms are obvious in babies with congenital heart disease, such as appearing to struggle when suckling, being weak and sweaty, and sucking especially slowly compared to normal children, often taking 30 to 45 minutes. They may also have shortness of breath. On closer inspection of the child’s chest, the ribs protrude and the front chest is sunken. If left untreated, they grow up with lower physical capacity than their peers, have lower physical endurance, and are prone to shortness of breath and fatigue due to rising lung pressure.
Multiple defects may occur in heart disease
The following common types of congenital heart disease were explained. He noted that some congenital heart diseases also present with more than one defect, and some present with multiple defects, varying from mild to severe.
Atrial septal defect (ASD): An atrial septal defect is a defect that occurs between the chambers of the upper part of the heart (atria), commonly known as a hole in the upper part of the heart. The function of the atria is to receive blood back to the heart. If there is a hole in the atrial septum, a short circulation is created between the lungs and the heart in the blood. The patient will thus have shortness of breath, difficulty feeding, excessive sweating, and lack of weight gain. Ventricular septal defects are usually detected in children after the age of 1 year, and symptoms are less pronounced in children with atrial septal defects.
Ventricular septal defect (VSD): Ventricular septal defect is a defect that occurs between the chambers of the lower part of the heart (ventricles), commonly known as a hole in the lower part of the heart. The function of the ventricles is to pump blood out of the heart. When the heart has a ventricular septal defect, blood also forms a short circulation between the lungs and the heart. Children with this type of defect will have more symptoms such as shortness of breath, difficulty feeding, excessive sweating and lack of weight gain.
Atrioventricular septal defect (AVSD): This is a malformation of the heart caused by underdevelopment or arrest of the endocardial cushions during embryonic development. This heart defect, which causes severe shortness of breath and cardiomegaly in patients, is easily diagnosed at an early age. Surgical repair of the defect is usually required. If the condition is delayed until the adult stage, surgical treatment is no longer easily effective because damage to the lungs has already developed. Down’s children tend to have this defect.
Patent ductus arteriosus (PDA): A patent ductus arteriosus is an abnormal passage between the aorta and the pulmonary artery.
The ductus arteriosus allows arterial blood to be shunted to the lungs. During fetal life, this function is present, and because the fetus cannot breathe air, blood does not need to flow through the lungs for gas exchange. After birth, however, blood must flow to the lungs for gas exchange. Normally, the ductus arteriosus closes a day or two after the baby is born. If the ductus arteriosus is not closed, the arterial blood flowing throughout the body returns to the lungs, the blood flow in the pulmonary circulation increases, and the infant may develop heart failure, which is characterized by dyspnea, rapid heart rate, and lack of weight gain. Preterm infants with arteriovenous ductus insufficiency are more common than full-term infants.
Aortic stenosis: The aortic valve normally consists of three valves that close or open to allow blood flow through. In patients with aortic stenosis, the aortic valve has only two leaflets, resulting in incomplete opening and restricting blood flow. The left ventricle must use greater pressure to pump blood out of the valve opening. Some children with severe aortic stenosis develop heart failure and reduced systemic blood flow and require emergency treatment, which may include medication, surgery, or balloon valvuloplasty.
Aortic stenosis: It often occurs at the junction of the aorta and the ductus arteriosus, or in the descending aorta and the celiac artery.
The aorta carries arterial blood from the heart to various parts of the body. Aortic constriction results in decreased blood flow to the lower extremities, with lower than normal pulses and blood pressure in the lower extremities and higher than normal pulses and blood pressure in the upper extremities. In most cases, aortic constriction does not cause any problems. Some children develop headaches and nosebleeds due to high blood pressure in the upper extremities and pain in the lower extremities after exercise due to low blood pressure in the lower extremities, but most are asymptomatic. Children with aortic constriction also often have an abnormal aortic valve, which is only bilobed.
Children with aortic constriction may develop severe heart failure a few days to two weeks after birth, after heterotube closure, and may have difficulty breathing and become pale. Blood tests show a significant increase in blood acidity (metabolic acidosis). This condition is seriously life-threatening and requires prompt correction of the acidosis and appropriate treatment.
Pulmonary valve stenosis: When the pulmonary valve is open, blood flows from the right ventricle to the lungs. If the pulmonary valve is narrowed, the right ventricle has difficulty pumping blood and requires greater force to allow blood to flow through the pulmonary valve. Pulmonary valve stenosis in newborns varies in severity; mild cases do not require treatment, while severe cases may be life-threatening. If the pulmonary valve stenosis is very severe, only little venous blood flows to the pulmonary circulation for gas exchange, and the pressure in the right ventricle and right atrium increases secondary to venous blood flowing through the right and left atrial septum, to the left ventricle, aorta, and then to various parts of the body. As a result, the infant may develop cyanosis and require emergency treatment.
Heart defects are formed in the first trimester fetus, said Associate Professor Guo, adding that the heart is roughly formed in the first trimester of a woman’s conception, and if there is a heart defect it also occurs at this time. Basically, congenital heart disease cannot be prevented because there are many factors that cause defects in the heart organ.
The Ministry of Health wants women to get the German measles vaccine as early as possible, which apparently helps prevent congenital heart disease. However, he noted that there are several other viruses that are believed to cause defects to occur as well. Women are encouraged to have children early, as the risk of giving birth to a baby with congenital heart disease increases considerably when a pregnancy occurs after the age of 35. He also reminded pregnant women to pay attention to a balanced diet and to undergo regular gynecological examinations.